cardiac rehailitation

bed rest vs move early
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Terms in this set (28)
bed rest vs move early
history cardiac rehabilitation (what used to happen vs now)
RF management, lifestyle advice, structured exercise education, psychological support, social support
core components of rehabilitation (5)
influence positively the cause of the disease, preserve/resume optimal function, slow/reverse disease progression
definition of cardiac rehabilitation (only the key points)
Post MI/CABG/PCI/stable CAD/ chronic HF, GUCH, complex devices, cardiac transplant, valve/other surgery
who is for rehab
reduce risk of adverse events, improve symptoms, curtail physiological and psycho-social effects of heart disease, reintegrate patients to the community with good function
goals of rehabilitation
reduce mortality, reduce adverse events, reduce rehospitilisation, increase smoking cessation, improve function, weight reduction, lower BP/ lipids, improve diabetic control
benefits of rehab
hard to properly double blind, meta-analysis brings different data, common sense states its a good thing, reporting bias, patients self-select
why is it so hard to evidence
reduce total, LDL and TG's increase HDL, improve compliance with meds
impact on lipids due to exercise training
target under 140/90, long term reduction by 10-20 points, lifestyle choice (loose weight, salt intake, less alcohol), improve medication compliance
impact on hypertension due to exercise training
improved glucose tolerance, lower serum insulin, reduce TG's and body fat, improved diet compliance, improved meds compliance
impact on diabetes due to exercise training
education, lifestyle risk factor management, psychosocial health, medical risk management, long-term strategies, audit and evaluatesix core componentsin hospital pre-discharge (assess, educate, reassure, assess risk) mobilise, discharge planningphase 1at home post discharge, personal exercise programme, stress management and reinforce health education, daily exercise routines around the home, telephone contact if necessaryphase 2community, exercise programme individualised, assess capacity to exercise, multi-modal, health education and psycho-social supportphase 3MDT, nurses, physio, exercise, diet ETCpeople involved in rehabilitationwarm up, aerobic circuit exercise, resistance (only a little), cool downstructured exercise programmeborg scale aim for moderate 4-6 levelwhat scale do we use to measure exercisecope with illness, improve QOL, improve complianceeducation helps patients toassess diet, calories sat fats and salt, target 20-25 BMI, target waist of 38/34 m/f, reduce calories, exercise moreweight optimisation is the process in which patientsstop, stop if need be smoking cessation programmesmoking cessation advicelow sat fats, increase poly/monounsaturates, complex carbs, adequate proteins, increase fibre, plant based food at 2000-2500 calories a daynutrition reomendationscreen for distress, anger, depression anxiety, enquire about social issues like isolation, occupation, marital/partner problems, sexual dysfuctionpsycho-social managementlife-long maintenance, unsupervised exercise, any setting up to patient, moderate 60-70% cardiac effort exercisephase 4co-morbidity, too ill, apathy, lack home support, geography/transport, group session, exercise modality, return to work, other commitmentbarriers to recruitment/uptakealternative delivery, home/online, make multimodality possibleimproving recruitmentdeliver 6 core components by MDT, prompt ID and recruitment of patients, early assessment, early provision of rehab, assess individual needs on completion, data submission to auditsix standards to cardiac rehabadress variation in standards and inequality in provision, NICE guidelines, KPI's identified and action plans developed, re-auditclinical audits, use3 different staff types, all priority groups included, phase 3 lasts 8 weeks and starts <33 days (hid 46 days CABG), assessment initially from hospital, final assessment after completionKPI's of cardiac rehab